Judicial action/mandate: A court or Michigan Administrative Hearing System (MAHS) administrative law judge ordered payment of the claim.Medicaid beneficiary eligibility/authorization was established retroactively.Department administrative error has occurred.Exceptions to Timely Filing Limits Acceptable exceptions to the timely filing limits for claims submission include the following: Claims exceeding the new timely filing limits (over 1 year from the DOS) will be denied unless the claim meets exception(s) as listed below.Ī. In addition, claims for services furnished prior to Janumust be submitted no later than December 31, 2017.
Blue cross timely filing professional#
For Institutional invoices, this will be calculated using the Claim Header “To/Through” date of service reported for professional and dental invoices, this will be calculated using the Claim Line “From” date of service. Timely Filing Limits for Claim Submission Medicare MichiganĮffective January 1, 2017, claims must be filed no later than one calendar year from the date of service (DOS). The claim must be received within 120 days from date of service to be considered timely. If the claim is not in our system, please submit the claim to Cigna-HealthSpring immediately. IMPORTANT: If you have NOT received a Remittance Advice within 45 days for a claim you have submitted, please check status online through HSConnect. ** If you are uncertain of your EDI claims activity, contact your clearinghouse first to ensure your claims are being transmitted correctly. Therefore, it is imperative to check the daily Rejection Report from your clearinghouse for any claims that may not have been accepted by your clearinghouse, Cigna-HealthSpring’s clearinghouse or Cigna-HealthSpring. ** When using EDI, your claims may be sent to your clearinghouse, but may NOT have been received by Cigna-HealthSpring. Claims submitted to Cigna-HealthSpring after these time limits will not be considered for payment. ** NOTE: Billing system print screens are NOT ACCEPTED for proof of timely filing. The denial MUST BE SUBMITTED along with the claim for payment consideration. ** INITIALLY FILED TO INCORRECT CARRIER – must be received at CignaHealthSpring within 120 days from the date of the denial on the incorrect Carrier’s EOB/RA (as long as the claim was initially filed to that carrier within 120 days of the date of service). These claims must be clearly marked “CORRECTED” in pen or with a stamp directly on the claim form.
** CORRECTED CLAIMS – must be received at Cigna-HealthSpring within180 days from the date on the initial Cigna-HealthSpring Remittance Advice. ** SECONDARY FILING – must be received at Cigna-HealthSpring within 120 days from the date on the Primary Carrier’s EOB. ** INITIAL CLAIM – must be received at Cigna-HealthSpring within 120 days from the date of service. To ensure your claims are processed in a timely manner, please adhere to the following policies: Do not send your request to WPS Medicare using the Redetermination Form. WPS Medicare Redeterminations unit cannot grant any waiver to timely filing deadline after the claim probably was processed, since claims denied for timely filing do not have appeal rights. In rare cases, CMS permits Medicare contractors to extend time limit for filing a claim beyond the usual deadline if provider may show good cause for delay in filing the claim. As a result, in such situations, providers must file the claim promptly after error was probably corrected. CMS indicates that Medicare contractors could determine good cause exists when an administrative error on an official part Medicare employee acting on Medicare behalf contractor within scope of his/her authority caused the delay. There have probably been no appeal rights on denied claim. Circumstances such as backdated Medicare entitlement may as well qualify for a timely extension filing deadline. The following is important information regarding recent New York State Managed CareĮffective April 1, 2010, New York State Managed Care regulations stipulate that health careĬlaims must be submitted by health care providers within 120 days of the date of serviceĬenters for Medicare Medicaid maintenance requires Medicare contractors to deny claims submitted after timely file limit is expired.
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